- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $1,584.89 / $8,128.31
| Facility | | $263.03 | $1,584.89 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $1,548.82 / $2,884.03
| Professional | | $177.83 | $1,548.82 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,238.72
| Professional | 50 | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $10,715.19 / $11,220.18
| Facility | | $6,760.83 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $1,659.59 / $3,311.31
| Professional | | $177.83 | $1,659.59 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $263.03 / $2,511.89 / $5,011.87
| Professional | 50 | $263.03 | $2,511.89 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $269.15
| Facility | | $162.18 | $223.87 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $234.42 / $275.42
| Professional | | $181.97 | $234.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $309.03 / $309.03
| Facility | | $34.67 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $2,511.89 / $17,378.01
| Professional | | $213.80 | $2,511.89 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $4,677.35 / $8,511.38
| Facility | | $1,000.00 | $4,677.35 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $1,513.56 / $5,011.87
| Professional | | $186.21 | $1,513.56 | $5,011.87 |